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HomeMy WebLinkAbout10340-zFORM NO. 4- TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's '{5~flce Southold, N.Y. Certificate Of Occupancy No....Z. ?9?*. ...... Date .... .D.~.e ,e .nl .b. o?. . .1.9. .............. , 19 .~.0. THIS CERTIFIES that the buil&ng ................................................ 17.5~... S..Iggre...Driv..e, Gree.np. ort, .~, y., ......... Location of Property h[~s'o ~1o. ' ...... '~'tt:e3[ ............ Ham/et County Tax Map No. 1000 Section .... Q.67 ..... Block ...0.~ .......... Lot ...O~. ........... Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Buildmg Permit heretofore filed in this office dated ....A.l,t.g.~.8..~..1 ......... , 19 7.9. pursuant to which Building Permit No. , .~0. ~./~.0.. Z. ........... dated ...A...~g3l...~.~...3., .............. 197..9., was issued, and conforms to an of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued ~s ......... Garage conversion and second floor addition on existing dwelling. The certificate is issued to Howard Iqilliams ?o¥.~;,~ ........... of the aforesaid building. Suffolk County Department of Health Approval .... .~../..13 .................................. UNDERWRITERS CERTIFICATE NO ...... N. 665.78.3 ............. .../ ............... / Building Inspector Rev 4/79 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N,. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: pursuant to application dated :..~.....~ .............. , 19..~, and ~pproved by the Building Inspector. ....... ~/~¥;; -~;~;~;; ......................... FORM NO. 6 TOWN OF SOUTHOLD , Building Depo~tment Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A This apphcation must be filled in typewriter OR ink, and submitted in DUPLICATE to the Building Inspector with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposal--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installations, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent in- formation ~equired to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use $5.00 3 Copy of certificate of occupancy $1.00 ............. New Building ................ Addition ..... ~.~ ....... Old or Pre-existing Building ................ Vacant Land .............. Locaton Of Property ...... ~ .... ~....'C.. ........ t.....J~/,..'. ...... ~ ..... Subdivision .............. > .............................................. Lot No ......~....... Block No..~..,.._House No..L.'~..~.,~-- Pe rmi* No./.0..~..~.~.~.. Date Of Permi~'~.~.~..~..Applicant ~ ...~4~~.: ........ Health Dept. Approval ..~.:..../~..., ........................... Labor Dept Approval J~. . Underwriters Approval 1./~.~......~...~..~'.~.2.~..~. ......... Planning Board Approval .~,.l,,,..~. Request For Temporary Certificate ........................................ Final Certificate ....~ .......................... Fee Submitted $ .....~../...~..'~.. ................. Construction on above described building and pea'nit meets all,~,applicable codes and regulations. Applicant ................................................. Sworn to before me this ................ day of ............................................ (stamp or seal) Noto ub,,c .................................... cou. I~0~ ~0. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT / TOWN CLERK'S OFFICE " ~/ SOUTHOLD, N. Y. Exam,ned ......................... -- , ,9. 7 App,,eot,an No. Approved ~,....~;~.~ ................. , 19'./..~ Permit No...~/."~...%-/.....~.,~. ..... Disapproved a/~ ................... ;~l~..~.., ~ ............ ~ ....... ~ .................. APPLICATION FOR BUILDING PERMIT ~ Date .......................... , a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premmses, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant Such permit shall be kept on the premises available for inspection throughout the work~ e. No building shall be occupled or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulatmons, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and it~ buildings for necessary,~Lpspections. ,-, ' ..... ..................... ....................... ........................ State whether applicant is own/e[, lesseex agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...~¢..~¢~Z.'~.~ ....... ~..~.~ ............................................................................ If applicant is a corporate, signature of duly author:ized officer. (Name and title of corporate officer) Builder's License No ....... Plumber's License No .... E,ectr c o 's ' cense .......... Other Trade's License No ............................................... 0 ' j/2.,.,~ Location of laniJ,o~n ,w~ic,h pxoposed wo.rk will ~be done. Map~o.: ..I....~..~.....~..-~.....~.... Lo.t ~o ......................... Street and ~..~...~~...;~-..~~'~ .......................... ~'"~ ...................... ~-- ~ Municipali~ State existing use and occupancy of premises and intended use and o~upanc~ ~f proposed ~onstruction' a Exisiting use and occupancy ....~~ ...... ~~~~.~~ ............ b. Intended use and occupancy ..]~~.~...~~.....~~/~ ~ ........................................... 3. Nature of work (check which applicable): New Building .................. Addition ............. Alteration ............... Repair .................. Removal .................. Demolition .................... Other Work ................................................... ~' i ~ (Description) 4. Estimated Cast ............ .<~...~..Z ...................................... tee ...................................................................................... ~ (to be paid on filing this application) 5. I If dwelling, number of dwellihg units ............. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front .......... Height ........................ Number of Stories ................................................................................................................. Dimensions of ~same structure, with alterations ~or addmons: Front .......... ~.....~. ................. Rear ........ ?......~?. ........... Depth ........ ..~..! .................. Hmght ..... ~ ............... Number of Stones ..... ~ ...................... 8. Dimensions of entire new coqstruction: Front .................................... Rear .......................... Depth ........................ Height .................... Numberl of Stories ..................................................................................................................... 11. Zon~ or use district in which ~remises are situated ........ l.~.~*~ ..................................................... 12 Does, proposed construction vialate any zoning law, ordinance or regulation: ......... ~.....~.. .............................. 13. Will lot be regraded . ..~ ........... Will excess fill be removed from premises: ~x/) Yes ( ) No 14. Name of Owner of premises .~....~..,:x~k.~k~. ..... Address .~..//.:~'. Phone No ....................... Nome of Contractor ~kZ,,~<~f',.....~...."~ .............. Address .k-~'~.~..?!...TPhone No ....................... PLOT DIAGRAM t.ocot~ clearly and distinctly ali buildings, whether existing or proposed, and indicate all set-back dimensions frorn property lines. G~ve street and block number or description according to deed, and show street names and indicate whether interior or corner lot ¢~TATE OF NEW/F~)RKJ/ ,, ,Z' ~ 'k c ..................... ~..... . . .. .~ .............. being duly sworn, deposes 'and says that he is the apphcam (Name or inaiviaua signing contract) abow~ named. [ Fie is the .................................. ~ ..................................................................................................... ' J (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statement~ contained in t, his application, are true to the best of his knowledge and belief; and that the work will be performed in t~e manner set forth in the applicatiop, filed therewith. Sworn to before me this ~'x / ) ~ /q ...... ~...~.... day of .................. ~C" 1~.. J/~'7/ 7~ :~) f/ .-. ~ Notg~:~'. Public,. ................ ,~. ....... ~ ~ou_nty .... ~.....~ .............................. ~.j~~ ~ (Signature of applicant) ~) FtI/At~tltl A,~N '~lVihi ~ ' ALBERT '~46~,5 MAIN BO,AD AND, GORDON K, AHLERS ARCHITECTS & ENGINEERS ~OU'r'4~LD N Y 11~71 .], · K, '~" I F N/'L - CoNSTI~UCTION MUST , ~ I~CTIOI% SHALL MEET ~4TE CONSTRUCT h"~N ~ODES. 'NOT RESP0~S~LE f ~ESIG~ OR cONSTRUCTfON O,,z: ,-=/~' 0 © ALBERT A, S;k,~CO ,,;,~o..,,. . ,,,.; I<.'. Z Lb .... Ou c'r , ,,v~ c:; ;~CK--,' ,~,~c; ED l I~'i ~7 N ~ I cB' t-4 C u P c, ~A ,,? ~.=, O To c7o__r:4 ?l.',-,-: :0 3CG,~ 2'k 6'~/G O,C, 5, F E t_ ~,.K. COT f E,e:...L, ALBERTA SACCO ~.